Tests and diagnosis

To measure your blood pressure, your doctor or a specialist will usually place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge.

A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).

Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.

Both numbers in a blood pressure reading are important. But after age 60, the systolic reading is even more significant. Isolated systolic hypertension is a condition in which the diastolic pressure is normal (less than 90 mm Hg) but systolic pressure is high (greater than 140 mm Hg). This is a common type of high blood pressure among people older than 60.

Your doctor will likely take two to three blood pressure readings each at three or more separate appointments before diagnosing you with high blood pressure. This is because blood pressure normally varies throughout the day, and sometimes specifically during visits to the doctor, a condition called white coat hypertension. Your blood pressure generally should be measured in both arms to determine if there is a difference. It's important to use an appropriate-sized arm cuff. Your doctor may ask you to record your blood pressure at home and at work to provide additional information.

Your doctor may suggest a 24-hour blood pressure monitoring test called ambulatory blood pressure monitoring. The device used for this test measures your blood pressure at regular intervals over a 24-hour period and provides a more accurate picture of blood pressure changes over an average day and night. However, these devices aren't available in all medical centers, and they're rarely reimbursed.

If you have any type of high blood pressure, your doctor will review your medical history and conduct a physical examination.

Your doctor may also recommend routine tests, such as a urine test (urinalysis), blood tests, a cholesterol test and an electrocardiogram — a test that measures your heart's electrical activity. Your doctor may also recommend additional tests, such as an echocardiogram, to check for more signs of heart disease.

Taking your blood pressure at home

An important way to check if your blood pressure treatment is working, or to diagnose worsening high blood pressure, is to monitor your blood pressure at home. Home blood pressure monitors are widely available and inexpensive, and you don't need a prescription to buy one. Talk to your doctor about how to get started. Home blood pressure monitoring isn't a substitute for visits to your doctor, and home blood pressure monitors may have some limitations.

What is high blood pressure? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/. Accessed April 3, 2015.

What is high blood pressure? American Heart Association. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/What-is-High-Blood-Pressure_UCM_301759_Article.jsp. Accessed March 19, 2015.

James PA, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). The Journal of the American Medical Association. 2014;311:507.

Eckel RH, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2014;63:2960.

Prevention and treatment of high blood pressure. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/PreventionTreatmentofHighBloodPressure/Prevention-Treatment-of-High-Blood-Pressure_UCM_002054_Article.jsp. Accessed April 8, 2015.

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